About Barbara Starfield

Barbara Starfield, M.D., M.P.H., dedicated her career to defining primary care and promulgating its pivotal importance to health services worldwide. One of her profound insights was that systems of care organized around individual diseases were not optimally beneficial to patients, especially those who are chronically ill.

Research by Prof. Starfield and her colleagues in the early 1980s showed that children using the most health care resources were not those affected by single chronic illnesses, but rather they had multiple, seemingly unrelated conditions. Prof. Starfield was able to extend these findings to all ages of patients and ultimately demonstrate that the clustering of morbidity is a better predictor of health services resource use than the presence of specific diseases.

Focusing on the patterns of morbidity forms the basis of the current ACG System and remains the fundamental concept that differentiates the ACG System from other case-mix adjustment methodologies. Although Prof. Starfield passed away in 2011, her worldwide public health legacy lives on.

Discovery Limited Receives 2016 Starfield Award

Lizelle Steenkamp and Sharon Naidoo received this award on behalf of Discovery Limited in South Africa in recognition of their use of the Johns Hopkins ACG System in their project entitled “Improving Patient Coordination Through Effective Primary Care Management”. Their work was presented at the 2016 ACG System International Conference in San Diego.

Discovery Limited used the Johns Hopkins ACG System to investigate the impact of care coordination on health care costs and patient health outcomes. By modifying the ACG System coordination risk score to better suit the South African population and patterns of care, Discovery Limited was able to measure the impact of primary care provider allocation. Results demonstrated that assigning a primary care doctor to a patient for care coordination improved care coordination as measured by decreased number of specialist visits and decreased number of hospital admissions and readmissions. Improvements were also seen in process measures recorded within diabetes and healthy heart management.

“We are immensely honored to receive this award in recognition of a project using the ACG System to measure the impact of primary care provider allocation,” said Dr. Jonathan Broomberg, CEO of Discovery Health. “For Discovery it is critical that we continue to maximize value for patients. Projects such as these make excellent use of tools such as the ACG System and support our efforts to move towards a patient-centered health care system, which aims to achieve the best patient outcomes at the lowest possible cost,” Broomberg continued.

Discovery Limited’s study also showed that the specialty of the doctor providing the majority of care is not as important as previously thought. Instead, the strength of the relationship between the patient and the provider has a greater influence on successful care coordination. Patients with strong relationships with their primary care providers had better utilization experiences than those with weak relationships. This is independent of insurance benefit design as patients with strong relationships with general practitioners on both unrestricted and restricted plans experienced lower levels of hospital utilization. They also experienced lower care coordination issues.

“Results from this project demonstrated that coordinated care, by assigning a primary care doctor to a patient, lowered overall health care costs and improved patient outcomes,” confirmed Broomberg. Commenting on their work in coordinated care, he said, “Discovery Health places great emphasis on coordination of patient care and the subsequent evidence of improved care and costs. Measured by a decreased number of specialist visits and hospital admissions and readmissions, this project also showed that our patient-care strategy using the Discovery Health Premier Practice model is effective,” he added.

The findings support the Discovery Premier Practice model that was introduced in 2015 and provides an approach that encourages care coordination within the health care system namely the Discovery Premier Network. This network consists of general practitioners who agree to follow evidence based pathways for the management of patients with the following conditions: diabetes, hypertension, hyperlipidemia or coronary artery disease. Enrolled doctors are incentivized to manage their patients’ care. The Premier Network is unique in that it is coupled with Discovery’s wellness program, Vitality. Vitality members are incentivized to reach particular health goals.

“Given Professor Starfield’s conviction of the importance of coordinated care as well as her input during the creation of the ACG System Coordination Markers, it is truly fitting that the work of this year’s Starfield Award winner focusses on these aspects,” said Karen Kinder PhD, MBA; Executive Director, ACG System

To access a summary presentation highlighting their award-winning work, click here.

About the The Starfield Award

The Starfield Award honors the work and legacy of Dr. Barbara Starfield, co-developer of the Johns Hopkins ACG System. We are honored to receive numerous applications from leaders in health care research from across the globe. The award recognizes work focusing on three major aspects of Barbara Starfield’s work; addressing multi-morbidity in patients and populations, reducing disparities in the delivery of primary health care, and improving population health. The ACG System Team is grateful to DST for sponsoring this award. It is awarded biennially and presented at the ACG International User Conference.

Medscheme Receives the Inaugural Starfield Award

Lourens Walters, Cristina Mannie, and Stefan Strydom of Medscheme in South Africa received the 2014 Starfield Award in recognition of their use of the ACG System in their project titled: “A comprehensive care management programme focused on emerging and high risk individuals”.

They presented their work at the 2014 ACG System International Conference in Seattle, WA.

The aim of Medscheme’s research was to identify individuals within lower morbidity groups who were most likely to incur increasing health care costs in the future but are still amenable to care management intervention programs. What differentiated their approach from other methods of identifying patients for care management programs was their recognition that when tracking costs over future time periods for individuals in the lower Resource Utilization Bands (RUBs), the average health care expenditure for these individuals increases dramatically even though their current costs are relatively lower than those associated with higher RUBs.

A predictive model utilizing the ACG System was developed to predict the likelihood of moving to a higher RUB in the future. This new Emerging Risk Model complements their existing care management approach of focusing on high risk individuals.

By intervening on high risk individuals identified by applying their existing High Risk Predictive Model which also utilizes the ACG System, their randomized controlled study observed financial savings and a reduction in utilization of hospital services. Individuals identified by the Emerging Risk Model are likely to benefit from similar interventions due to a similar disease profile. A randomized controlled study is planned to measure intervention outcomes.

About the The Starfield Award

The Starfield Award honors the work and legacy of Dr. Barbara Starfield, co-developer of the Johns Hopkins ACG System. This year we were honored to receive numerous applications from leaders in health care research from across the globe. The award recognizes work focusing on three major aspects of Barbara Starfield’s work; addressing multi-morbidity in patients and populations, reducing disparities in the delivery of primary health care, and improving population health. The ACG System Team is grateful to DST for sponsoring this award. It is awarded biennially and presented at the ACG International User Conference.